Factors Influencing Utilization of the Makueni Care Insurance Program Toward Universal Health Coverage in Makueni County, Kenya

Abstract

Health financing involves raising adequate funds for health services in ways that ensure people can access needed care without facing financial hardship or impoverishment. It also provides incentives for efficiency among both providers and users. Health insurance schemes play a central role in improving access to healthcare by pooling resources to reduce the financial burden on individuals and families. Such schemes are vital in advancing Universal Health Coverage (UHC) by ensuring equitable, affordable, and accessible health services. The Makueni Care Insurance Program (MCIP), implemented in Makueni County, Kenya, represents a key initiative toward achieving UHC. However, its success has been constrained by challenges related to funding, accessibility, affordability, and equity. This study focused on these factors to provide actionable insights for strengthening MCIP and similar health insurance schemes. Specifically, the study aimed to examine the influence of accessibility, affordability, equity, and funding on the utilization of MCIP in achieving UHC in Makueni County. The study targeted two primary groups: Hospital Administrators and Healthcare Providers, and Beneficiaries and Program Users. The Hospital Administrators and Healthcare Providers group comprised approximately 192 individuals, including 128 Hospital Administrators and 333 Healthcare Providers drawn from 16 public hospitals across Makueni County. The sample size was determined using Yamane’s formula at a 5% precision level, resulting in 45 hospital administrators and 99 healthcare providers. In addition, purposive sampling was used to select 40 program beneficiaries from each of the four facilities—Makueni County Referral Hospital, Emali Sub-County Hospital, Makindu Sub-County Hospital, and Kibwezi Sub-County Hospital—yielding a total of 160 beneficiaries. Stratified sampling was applied to ensure proportional representation across the facilities. A descriptive cross-sectional survey design was employed to gather quantitative data from program users, inpatients, and healthcare providers across the selected public health facilities. Data were collected using structured questionnaires tailored for program beneficiaries, administrators, and healthcare providers. The data were analyzed using SPSS (Version 26), applying Spearman rank correlation and multivariate regression analyses to evaluate relationships between the key factors and MCIP utilization. The findings revealed that funding, accessibility, affordability, and equity all played critical roles in improving the utilization of health insurance schemes such as MCIP. Specifically, affordability (β = 0.263, p < 0.001), accessibility (β = 0.167, p = 0.001), equity (β = 0.201, p < 0.001), and funding (β = 0.217, p < 0.001) had statistically significant positive effects on MCIP utilization. Among these, affordability had the strongest influence, underscoring the importance of financial considerations in beneficiary engagement. Based on these results, the study offered evidence-based recommendations for policymakers and stakeholders to enhance MCIP’s effectiveness. These included strategies to promote sustainable funding, improve service accessibility, ensure affordability through reduced premiums or subsidies, and strengthen equity in healthcare delivery. Implementing these interventions will foster greater enrollment and continued use of MCIP services, ultimately contributing to improved health outcomes and the realization of UHC in Makueni County and beyond.